Human immunodeficiency virus infection in patients on maintenance dialysis.

Dr. Lago Alonso, Nephrology Department, Hospital General Universitario ‘Gregorio Marañón’, Calle Doctor Esquerdo no 46, E-28007 Madrid (Spain) Dear Sir, Seven years ago we asked ourselves what was the best dialysis schedule for patients with HIV infection [1]. In 1994, we reviewed our experience with HIV-positive patients on chronic maintenance dialysis (D). Nine patients with HIV infection were treated on dialysis, between June 1987 and June 1993, in the Gregorio Marañón Hospital in Madrid. This Hospital attended ‘Health Area 1’ of Madrid: 627,000 inhabitants and 285 patients on maintenance dialysis. In 5 of 9 patients, HIV antibodies (Ab) were detected in June 1987, the first time we tested all patients on D, for HIV Ab (group 1). Since June 1987, all patients on dialysis have been tested for circulating anti-HIV Ab, by ELISA, every 4 months. New patients are also tested for HIV Ab when they are included in supportive dialysis therapy. If serum is positive by the ELISA method in two samples, a Western blot assay is performed (HIV+). PCR is used in doubtful cases. Ab screening for HIV infection by standard ELISA sometimes yields false-positive results in patients with renal failure (2); therefore, it is especially important to confirm HIV+ with the Western Blot test [3, 4]. Since 1987, blood and organ donors are tested systematically in our hospital. Between 1987 and 1993, only 4 patients who were HIV seropositive before developing renal insufficiency were included into the D program (group 2). Access to dialysis treatment has not been limited for these patients. The proportion between HIV+/HIVpatients who began D during the last 6 years was 1.14%. The amount of HIV+ patients who underwent D, with respect to all HIV+ patients of our hospital, was 0.2%. The prevalence of HIV seropositive patients on dialysis decreased from 2.1 % in 1987 to 0.34% in 1993. The high mortality rate after AIDS diagnosis of these patients, 63% annually, explains that decrease. HIV+ patients on dialysis are younger than our general dialysis population. The mean age of our dialysis patients is 55 years old; only 1 HIV+ patient is 56 years old. Four of 5 HIV+ patients on chronic D in group 1 are females; however, all HIV+ patients in group 2 are males. Glomerulone-phritis is the most common cause of end-stage renal disease in these patients. Patients on chronic D prior to HIV diagnosis were a mean of 75 months on this therapy before